Provider Demographics
NPI:1598872715
Name:MAYFIELD, TRACY L (DMD PHD)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:L
Last Name:MAYFIELD
Suffix:
Gender:F
Credentials:DMD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 VILLAGE PARKWAY
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:AL
Mailing Address - Zip Code:35080
Mailing Address - Country:US
Mailing Address - Phone:205-620-9222
Mailing Address - Fax:
Practice Address - Street 1:215 VILLAGE PARKWAY
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:AL
Practice Address - Zip Code:35080
Practice Address - Country:US
Practice Address - Phone:205-620-9222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL44481223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL05466OtherBCBS OF AL